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LAND USE PERMIT APPLICATION — Burnett County, W1 <br /> N ~ • <br /> Permit Fees: t t I <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 C7 5u <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> m <br /> Commercial/industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 I <br /> Accessory Structure-Commercial Cl &Il) $200 Addition to Accessory Structure-Commercial Cl &11 $200 SU ' y <br /> Deck/Stairs/Patios 1 $125 1 Gazebo(WI Stat 59.692(lv)) 1 $350 <br /> Camping Unit 1 $100 Filling/Grading $150 �= <br /> Permit Extension Valid for one year-Only 1 Allowed $100 9 x <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. y �Uvt <br /> d <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,retaining walls. <br /> v <br /> m <br /> Applicant Complete All Sections Below This Line S . <br /> Applicant's Name: JGrtriry LAL Oc_5ifer /t1�eSo� J <br /> Applicant's Mailing Address: 881'T C 16ew Lk 92 Sim- <br /> City State zip OQ <br /> Applicant's Telephone Number: (e/L - -?9 9 ' 'Y5-35- <br /> Applicant's <br /> s35- <br /> Applicant's Email: 0"?05 Qrl Sart f2t a'/. CC) 1 <br /> Lal •"^ n'd <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. Vv <br /> ❑Letter p DflPhone ❑Email N <br /> o� <br /> Legal Description:_ 5 zo r38 N /�17 W <br /> L <br /> Lot#: CSM Vol. Pg. OR o ~ <br /> a. 1 . <br /> Lot#: Block#: Subdivision Name: OR „ <br /> Gov't Lot#: OR 1/4 1/4 1 E <br /> Section#: Town#: N Range#: W Town of: tin 1 r)S O 1 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* �✓ 1 <br /> � 3 <br /> Parcel#(24 digits): <br /> Z�//O z <br /> Tax ID#(1-5 digits): o <br /> Property Site Address#:100 . <br /> Road Name: I o m5� City:S;re- <br /> TYPE <br /> re-TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:�CD <br /> Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure m <br /> ElPermit Extension LlGazebo-WI Stat 59.692(iv) ❑ Camping Unit ElCommercial Acc. Addition 4 ��/�'JJ <br /> n NZ c <br /> Proposed Structure/Addition Use: 61f1P_ > Q Z <br /> (Home/Cabin;Commercial Business;Bedroom;Deck:etc.) T Z <br /> nD <br /> Building Contractor: t�� /7���ei-N 5�im CrPP K Caas r Zr G)o o <br /> 1j <br /> '89P5Q I� .,Si t pin n Z r <br /> Anticipated Start Date: I l 5 n <br /> Page 1 of 4 `=J <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> z <br /> m <br /> a <br /> m <br />